Benefits of early versus later hypertension treatment and control on cardiovascular outcomes in those with diabetes: clinical and research implications
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Background/Aims: The benefits of early hypertension (HT) control in patients with diabetes (DM) may vary by degree of BP control achieved in the year after HT onset.
Methods: Retrospective cohort study, of 13,480 DM who met study criteria for new onset HT based on blood pressure (BP) measurements, ICD-9 HT diagnose, and pharmacy data. Multivariate logistic and proportional hazard regression models were used to model the impact of BP control in first year and baseline comorbidity on subsequent occurrence of stroke or acute myocardial infarction, with adjustment for demographic factors, comorbidities, and diabetes severity.
Results: During a mean of 37 months of follow-up time the rate of major CV events in those whose mean BP in the 12 months after HT onset was < 130/80 mm Hg, 130-139/80-89 mm Hg, and > 140/90 mm Hg was 4.9, 5.1, and 7.8 major CV events per 1000 person years respectively. CV events rates did not differ significantly for those above or below 130/80 mm Hg, but were significantly lower in those <140/90 mm Hg compared to those who >= 140/90 mm Hg at the end of the first year after HT onset (p=.0002). In multivariate models, BP control was a significant predictor of stroke, but not of myocardial infarction.
Conclusion: Prompt control of HT within one year of onset significantly reduced likelihood of subsequent stroke. Benefits of BP control were not significantly modified by baseline comorbidities or severity of diabetes.